NEW LOCATIONĀ  1626 NE Alberta St, Portland OR 97211

INSURANCE VERIFICATION FORM

Contact Information

Treatment & Concerns

Insurance Information

For MVAs please list the company that insures your motor vehicle.
Click or drag files to this area to upload. You can upload up to 2 files.
Click or drag files to this area to upload. You can upload up to 4 files.
* Some health plans & ALL motor vehicle accident claims require a referral stating medical necessity. i.e., treatment to address a pain or injury complaint by a primary care provider.

For MVAs Only

Policies & Disclaimers

Privacy Policy

The information in this form includes your legally protected health information to be stored securely and kept confidential unless required by law. Your health information will only be shared with the providers involved in your treatment and office staff for the purpose of eligibility or pre-authorization submitted to your insurance company.

Our complete privacy practices and policies are listed online https://bodyawaremassage.com/privacy-policy/ and a written copy can be provided by request.

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Body Aware Massage all rights reserved 2019
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